Figure 1. TSH, T4 and T3 level from diagnosis throughout various thyroxin treatment doses till 2020.
Given the values of high TSH not suppressed by levothyroxine treatment, we started to think about alternative diagnosis that leads to persistent elevation of TSH for example TSH secreting tumor and TSH resistance. Magnetic Resonance Images (MRI) of the pituitary gland was ordered to exclude TSH secreting pituitary tumor which revealed normal pituitary gland size. See figure 2.